[Caroli's disease. Presentation of 8 cases studied with ERCP]. / Enfermedad de Caroli. Aportación de ocho casos estudiados por CPRE.

Eight patients with Caroli's Disease are presented, studied by Endoscopic Retrograde Cholangiopancreatography (ERCP) from January 1976 through January 1990. In this period of time 1,525 procedures were carried out, this entity thus representing 0.52% of patients submitted to ERCP in our population. Six patients were females, being female: male ratio 3:1. Mean age was 52 years (range: 40-75). All patients presented a clinical history of recurring episodes of abdominal pain and/or crisis of cholangitis. In the ERCP carried out in these eight patients, cystic dilatation of intrahepatic left lobe bile ducts were confirmed in five patients, dilatation generalized to both lobes in two, and affecting exclusively the right lobe in one patient.

[Immunological and biochemical factors associated with spontaneous bacterial peritonitis]. / Factores inmunológicos y bioquímicos relacionados con la peritonitis bacteriana espontánea.

A prospective study (June 1988-December 1989) of all patients admitted with ascites due to cirrhosis was undertaken: Biochemical and immunological factors which may have significance in the development of spontaneous bacterial peritonitis were determined. Among 56 patients (44 males and 12 females) SBP developed in 16% of the group. No age differences were found and the etiology of the cirrhosis was mainly alcoholic. Patients with SBP had lower alpha-2 globulin concentrations: 0.43 +/- 0.12 vs. 0.60 +/- 0.18 g/dl (p less than 0.05) and a lower prothrombin time: 41 +/- 13% vs. 69.5 +/- 13 vs. 69.5 +/- 21% (p less than 0.001). Patients with SBP had also lower ascitic fluid total protein 0.99 +/- 0.4 vs. 1.64 +/- 1.1 g/dl (p less than 0.01) as well as lower alfa-2 globulin: 0.065 +/- 0.012 vs. 0.096 +/- 0.067 g/dl (p less than 0.05); beta globulin, 0.11 +/- 0.047 vs. 0.2 +/- 0.17 g/dl (p less than 0.05); gamma globulin, 0.32 +/- 0.1 vs. 0.52 +/- 0.4 g/dl (p less than 0.05); IgG, 275 +/- 157 vs. 477 +/- 335 g/dl (p less than 0.05); C3, 9.2 +/- 3.2 vs. 17 +/- 13 mg/dl (p less than 0.01) and C4, 2.83 +/- 1.5 vs. 4.66 +/- 3.9 mg/dl (p less than 0.05) than patients without this complication.

[Fournier's disease: a report of 9 cases]. / Enfermedad de Fournier: aportación de nueve casos.

Nine cases of Fournier's gangrene diagnosed between 1982 and 1989 are reported. All were males with a mean age of 76 (47-82 years). Seven had a history of alcoholism and one had non insulin-dependent diabetes. Six patients also had an anal fistula which may have been the starting point of the infection. The causal agents were two anaerobes (Clostridium perfringens and Bacteroides fragilis) two gram-negatives (Morganella morgagni and Pseudomonas aeruginosa) and one, an unidentified gram-positive. In three patients a mixed intestinal flora was isolated and in another no germs were found. All were treated with broad-spectrum antibiotics and surgery. Seven patients survived and two died.

[Presenting forms and diagnostic procedures in gigantic hemangioma of the liver]. / Formas de presentación y procedimientos diagnósticos del hemangioma hepático gigante.

We present eleven patients diagnosed of giant hepatic hemangioma in the last 20 years. The diagnosis was confirmed in all the cases during laparoscopy or laparotomy. The mean age of the patients was 44.9 +/- 8.99; nine of them were women. Only two of the patients complained of abdominal pain. Five patients showed abnormal liver function tests; the most common finding was increased levels of alkaline phosphatase. We have reviewed the diagnostic tools employed: isotopic study of the liver with 99Tc, and labeled erythrocytes, abdominal ultrasonography, CAT, hepatic arteriography, laparoscopy, laparotomy and liver biopsy. Usually we employed more than one of these diagnostic methods. In the last years there has been a shift to employ less invasive procedures.